The

A Seminar on Safety and Collaborative Nursing

Care on GBS, MS, MG:

E.U.R.O.N.S
“Nurses’ Role in Enhancing
Client Care through
Understanding the Related
disorders Of the Nervous
Opening Prayer
HOUSE RULES!

3
 HOUSE RULE
------------------
• All participants are
expected to listen attentively
and actively cooperate in the
seminar.
• The participants will be
given time for bladder break.
 HOUSE RULE
------------------
• Using of cell phones or any
gadgets are not allowed while
the seminar is still ongoing.
• No one is allowed to make
unnecessary noise during
lecture, however one can
answer if the speaker asks a
question during the allotted
GENERAL OBJECTIV
-----------------------
• After 3 hours of seminar the
participants will be able to
develop their knowledge, skills
and attitude regarding MS, MG ,
GBS and Cranial Nerve
SPECIFIC OBJECTIVE
-----------------------
Cognitive:
• Define and explain the
concept of Guillain Barre
Syndrome, Multiple
Sclerosis, Myasthenia
SPECIFIC OBJECTIVE
-----------------------
Affective:
• Value the importance of
understanding GBS, MS,
MG, and the different
functions of the cranial
SPECIFIC OBJECTIVE
-----------------------
Psychomotor:
Apply the learned concepts
in GBS, MS, MG, and cranial
nerve assessment in
handling patients with such
INTRODUCTIO
N
THE NERVOUS
SYSTEM
SYSTEM
------------------------
• The nervous system is a
network of nerve cells and
fibers which transmits nerve
impulses between parts of the
body.
• It can be divided into two
SYSTEM
------------------------
The function of the
nervous system is to
control motor, sensory,
autonomic, cognitive
SYSTEM
------------------------
3 C’s
•Control
•Communicating
•Coordinating
SYSTEM
------------------------
•The central nervous system
 is the brain and spinal cord
• The peripheral nervous
system  includes the cranial
nerves, spinal nerves, and the
autonomic nervous system.
SYSTEM
------------------------
• Autonomic Nervous System –
divided into sympathetic and
parasympathetic nervous system
• regulates the activities of internal
organs
• restoration of internal homeostasis
AUTONOMIC NERVOUS
SYSTEM
------------------------
• The sympathetic nervous
system predominantly has
excitatory responses. It
prepares the body for situations
that require strength and
heightened awareness
AUTONOMIC NERVOUS
SYSTEM
------------------------
• The parasympathetic
nervous system has a
calming effect on the body. It
returns heart rate and
breathing to normal,
SYSTEM
------------------------
•Neurotransmitters–
communicate messages from
one neuron to another or to a
specific target tissue.
•It can either excite or inhibit
SYSTEM
------------------------
•Neurons (nerve
cells) - basic
functional unit of the
nervous system
 PARTS OF A NEURO
------------------------
• Dendrites-branch type structures
for receiving electrochemical
messages
• Axons- a long projection that
carries electrical impulses away
from the cell body
PARTS OF A NEURO
------------------------
• Cell body or soma - carries out
the basic life processes of
neurons
• Myelin Sheath – produced by
Schwann cells, it is a fatty and
protein material that serves as a
PARTS OF A NEURO
------------------------
•Neuroglial cells – 50
times greater in number
than neurons which serve
to support, protect and
nourish neurons
DEMYELINATION
destruction of myelin
CRANIAL
NERVES
26
INSERT CRANIAL
NERVES MUSIC
VIDEO!!!!!!!!
28
 CRANIAL NERVES
------------------------
12 pairs of cranial nerves
emerge from the lower
surface of the brain and
pass through the openings
in the base of the skull
The
cranial
nerves
are
numbere
d in
order in
which
they
arise
from the
 CRANIAL NERVES
------------------------
•3 Sensory
•5 Motor
•4 Mixed Sensory and
Motor
 DOM PLS
INSERT CRANIAL
NERVES TABLE TYYY
 CRANIAL
NERVES
ASSESSMENT
35
CRANIAL NERVES
ASSESSMENT
------------------------
Cranial nerves are assessed when
the level of consciousness is
decreased, with brain stem
pathology or in the presence of
peripheral nervous system
disease.
 EQUIPMENT
------------------------
• Tongue depressor • Snellen chart
• Flashlight • Ophthalmosco
pe
• Sugar and salt samples
• Watch • Samples of
• Cotton tipped swabfamiliar odors
• Tuning fork
Ophthalmos
cope
allows a health
professional to
see inside the
fundus of the
eye and other
DOM!!!!!!!!!!!!!!!!!!!
!!!!!!!!!!!!
INSERT CRANIAL
NERVES PROCEDURE
NEUROLOGIC
DISORDERS
40
GUILLAIN BARRE
ghee-yan bah-
ray’ syndrome
named after three French neurologists who
described the condition in two soldiers in
1916
(Brain Foundation , 2017)
2-8 out of
100,000
are affected by GBS; with most
people being aged 30-50yrs
(National Institute of Neurological
Disorders, 2014)
42
 GUILLAIN BARRE SYNDROM
------------------------
•A rare autoimmune neurological
disorder in which the body's immune
system attacks the peripheral nerve
myelin, the network of nerves located
outside of the brain and spinal cord.

•The result is acute, rapid demyelination

of peripheral nerves and some cranial
 3 TYPES OF GBS
------------------------
• Acute inflammatory demyelinating
polyradiculoneuropathy (AIDP)

• Miller Fisher syndrome (MFS) 

• Acute motor axonal neuropathy

(AMAN) or Acute motor-sensory
axonal neuropathy (AMSAN) 
 TYPES OF GBS
------------------------
1. Acute inflammatory
demyelinating
polyradiculoneuropathy
(AIDP)
• The most common form of GBS (85%)
• The most common sign is muscle
weakness that starts in the lower
OPHTHALMOPLEGIA
paralysis of the eyes
 TYPES OF GBS
------------------------
2. Miller Fisher syndrome
(MFS) 
• more common in Asia
• also associated with unsteady
gait
 TYPES OF GBS
------------------------
3. Acute motor axonal neuropathy
(AMAN) or Acute motor-sensory
axonal neuropathy (AMSAN) 
• characterized by acute paralysis
and loss of reflexes with or without
sensory loss
GBS – CAUSES/RISK FACTORS
------------------------
• Males are slightly more likely to
contract GBS.
• Risk increases with age.
• Influenza virus, HIV, Mycoplasma
pneumonia, Campylobacter jejuni, or
Epstein-Barr virus (EBV): most
common infections associated with
GBS – SIGNS AND SYMPTOMS
------------------------
INITIAL SYMPTOMS
• Changes in sensation
• Pain
• Muscle weakness beginning in the lower
extremities
• Tingling in the extremities
• Children will also show symptoms with
difficulty walking
GBS – SIGNS AND SYMPTOMS
------------------------
• Paresthesia (prickling, pins and
needles sensations in the fingers, toes,
ankles or wrists)
• Ascending weakness
• Dyskinesia (inability to execute
voluntary movements)
• Hyporeflexia or Areflexia
• Unsteady walking
GBS – SIGNS AND SYMPTOMS
------------------------
• Severe pain that may feel achy or
cramp like
• Difficulty with bladder control or
bowel function
• Rapid heart rate
• Low or high blood pressure
• Difficulty breathing
GBS – DIAGNOSTIC TESTS/LABS
------------------------
• Nerve Conduction Velocity Test - tests the speed
at which impulses travel through a nerve, it uses
electrodes placed on the skin over peripheral nerves
• Spinal Tap (Lumbar Puncture) - fluid contains
more protein than usual but very few immune cells.
This may take up to 10 days from onset of symptoms
to develop.
• Electromyography - measures the electrical activity
within muscle fibers by placing a needle electrode
through the skin directly into the muscle.
NERVE CONDUCTION VELOCITY
TEST
------------------------
 ELECTROMYOGRAPHY
------------------------
WHAT IS THE NORMAL VALUE OF
PROTEIN FOUND IN OUR CSF
15-45mg/dl
GBS – MEDICAL MANAGEME
------------------------
•Respiratory Therapy or
Mechanical Ventilation
•Plasmapheresis is a process of
removing blood, filtering out the
liquid plasma that contains
antibodies
•High dose immunoglobulin
therapy can block the damaging
antibodies that may contribute to
 PLASMAPHERESIS
------------------------
 HIGH DOSE I.G THERAP
------------------------
GBS – MEDICAL MANAGEME
------------------------
• 60-75% of patients recover
completely

• Around 30 %still experience some

weakness after three years. About
3% percent of people affected
by Guillain-Barré will experience a
 60-75%
of patients recover completely

30 %
still experience some weakness after
three years
3%
affected by Guillain-Barré will
experience a relapse of their
 GBS- NURSING DIAGNOSE
1. Ineffective breathing pattern /

------------------------
Impaired Gas Exchange related to rapidly
progressive weakness and impending
respiratory failure
2. Impaired physical mobility related to
paralysis
3. Imbalanced nutrition less than body
requirements related to inability to
swallow
4. Impaired verbal communication related
to cranial nerve dysfunction
 GBS- NURSING DIAGNOSE
1. Impaired physical mobility related to
------------------------
weakness and muscle paresis
2. Risk for injury related to sensory
impairment
3. Impaired urinary and bowel
elimination related to nervous system
dysfunction
4. Impaired verbal communication / Risk
for Aspiration related to cranial nerve
involvement
 GBS- NURSING
NTERVENTIONS
------------------------
• Monitor vital signs closely
• Explain the disease of GBS
• Manage respiratory needs
• Keep patient safe from falls risks
• Assist with ROM exercises at least
twice daily
• Facilitate change of position (to
prevent DVT and pulmonary
 GBS- NURSING
NTERVENTIONS
• Apply anti embolic stockings as
------------------------
ordered
• Collaborate and develop a
nutrition plan
• Assess return of gag reflex and
bowel sounds
• Establish forms of
communication through picture
 GBS- NURSING
NTERVENTIONS
------------------------
• Emphasize a positive appraisal of
coping resources
• Teach relaxation techniques
• Encourage diversional activities and
encouraging visitors to interact with
patient
• Provide pain management
 •PLEASE
INSERT HERE
THE VIDEO
ON
 MULTIPLE
SCLEROSIS
first well defined by neurologist Jean-Martin
Charcot in 1868, as 'la sclérose en plaques'.
 MULTIPLE SCLEROSIS
------------------------
• A progressive, immune-
mediated, demyelinating
disorder of the CNS

• Eventually, the disease can

cause permanent damage or
 MULTIPLE SCLEROSIS
------------------------
• A progressive, immune-
mediated, demyelinating
disorder of the CNS

• Eventually, the disease can

cause permanent damage or
4TYPES OF MULTIPLE SCLEROSI
------------------------
•Relapsing-remitting
MS
•Primary-progressive
MS
 TYPES OF MULTIPLE
SCLEROSIS
------------------------
Relapsing-remitting MS
• People with this type have attacks
when their symptoms get worse,
called relapses, followed by full,
partial, or no recovery. These flares
seem to change over several days
to weeks.
 TYPES OF MULTIPLE
SCLEROSIS
------------------------
Primary-progressive MS:
• Symptoms gradually get worse
without any obvious relapses or
remissions
• About 15% of all people with MS
have this form
• Most common type for people
 TYPES OF MULTIPLE
SCLEROSIS
------------------------
Secondary-progressive
MS
• People who get this type
usually start with relapsing-
remitting MS
• The change may happen
 TYPES OF MULTIPLE
SCLEROSIS
------------------------
Progressive-relapsing MS
• Least common form of Multiple
Sclerosis
• Symptoms steadily get worse, but
people also have flares that may
or may not be followed by some
recovery
MS – CAUSES/RISK FACTORS
------------------------
•Low Vitamin D
Levels
•Thyroid disease
 SCOTOMA
a partial loss of vision / patchy
blindness
MS – SIGNS AND SYMPTOMS
------------------------
•Fatigue (most common)
•Depression
•Weakness
•Numbness
•Loss of balance
MS – SIGNS AND SYMPTOMS
------------------------
• Pain
• Ataxia (impaired
coordination of movements)
• Spasticity (muscle
hypertonicity)
• Diplopia
MS – SIGNS AND SYMPTOMS
------------------------
END STAGE SYMPTOMS
• pain, spasms, tremors
• sensory changes
• bowel or bladder incontinence,
UTI, constipation
• difficulty chewing or swallowing
• speech difficulties
MS – SIGNS
AND
SYMPTOMS
MS – DIAGNOSTIC TESTS/LABS
------------------------
• Magnetic resonance
imaging (MRI)
• Electrophoresis of CSF a
technique commonly used in the lab to
separate charged molecules, it will
indicate presence of oligoclonal
banding
 MS– MEDICAL MANAGEME
• Disease-modifying therapies
------------------------
(DMTs)  for RRMS
Glatiramer acetate (Copaxone) –
increases antigen specific suppressor T
cells
May take 6 months for immune response
to appear
• Beta interrferons
-Savonex -Betaseron
-Avonex -Extavia
Side effects include flu like symptoms which
 MS– MEDICAL MANAGEME
------------------------
 Oral medications
• Dimethyl fumarate
(Tecfidera)
• Fingolimod (Gilenya)
• Teriflunomide (Aubagio)
Take with meals
 MS– MEDICAL MANAGEME
------------------------
  INTRAVENOUS INFUSION TREATMENT
FOR RRMMS:
• Alemtuzumab (Lemtrada)
• Natalizumab (Tyasbri)
• Mitoxantrone (Novantrone),-
administered every 3 months for
severe MS only. It reduces
frequency of relapses with
secondary progressive MS. Side
 MS– MEDICAL
• Corticosteroids
MANAGEME
------------------------
(pednisone,methyprednisolon
e)
-reduce nerve inflammation
and shorten the duration of
relapse.
 MS - NURSING
NTERVENTIONS
------------------------
• Educate the patient and her family
about multiple sclerosis
• Provide emotional and
psychological support
• Assist with active, resistive, and
stretching exercises
• Avoid strenuous activities
 MS - NURSING
NTERVENTIONS
------------------------
• Educate the patient and her family
about multiple sclerosis
• Provide emotional and
psychological support
• Assist with active, resistive, and
stretching exercises
• Avoid strenuous activities
 MS - NURSING
NTERVENTIONS
------------------------
 MS - NURSING
NTERVENTIONS
------------------------
• Instruct to perform coughing and
deep breathing exercises
• Maintain skin integrity
• Avoid hot temperatures
• Suction as needed
• Prevent aspiration
• Promote emotional stability
 MS - NURSING
NTERVENTIONS
------------------------
• Encourage regular rest periods
• Evaluate the need for bowel and
bladder training during
hospitalization
• Encourage adequate fluid intake
and regular urination
• Stress the importance of eating a
nutritious, well-balanced diet that
 •PLEASE
INSERT HERE
THE VIDEO
ON MS!!!!!!!
MYASTHENIA
GRAVIS
 Latin and Greek in origin meaning "grave,
or serious, muscle weakness."
 MYASTHENIA GRAVIS
------------------------
• A chronic, progressive autoimmune
disorder that affects the myoneural
junction
• Deficiency in acetylcholine receptor
sites in the myoneural junction.
• Characterized by varying degrees of
weakness of the voluntary muscles.
• Motor disorder with no effect on
 MYASTHENIC CRISIS
------------------------
•a life-threatening
condition
•weakness from
 myasthenia gravis that is
severe enough to
MG-CAUSES/RISK FACTORS
------------------------
•Females (20-40 years old);
Men tend to develop MG at 60-
70 years of age
• Autoimmune disease
• Hyperthyroidism
• Hyperplasia in the thymus
STRABISMUS
crossed or turned eye
MG-SIGNS AND SYMPTOMS
------------------------
MG-SIGNS AND SYMPTOMS
------------------------
Initial manifestation of MG
involves the ocular muscles
• Diplopia
• Ptosis (drooping of eyelids)
• Blurring of vision
• Strabismus
MG-SIGNS AND SYMPTOMS
------------------------
• Weakness of the muscles of the face
and throat
• Dysphonia (voice impairment)
• Dysarthria
• Flat facial affect, Facial drop
• Nasal, monotone speech
• Diminished vital capacity
 MG – DIAGNOSTIC
TESTS/LABS
------------------------
• Acetylcholinesterase Inhibitor Test
Endrophonium chloride (Tensilon)
administered IV to diagnose MG. 30 seconds
after the injection, facial muscle weakness and
ptosis should resolve for about 5 minutes.
Immediate improvement in muscle strength after
administration represents a positive test and
usually confirms the diagnosis.
ANTIDOTE: Atropine should be available to
 MG – DIAGNOSTIC
TESTS/LABS
------------------------
•Chest X-ray or CT scan-
thyoma or hyperplasia of
thymus gland
•Electromyogram - a test
that is used to record the
FASCICULATIO
N
muscle twitch
 MG– MEDICAL MANAGEME
• Anticholinosterase medications
------------------------
– first line of therapy that
provides symptomatic relief
• Pyridostigimine Bromide
(Mestinon) – fewer side effects
• Side effects: abdominal pain,
diarrhea, fasciculation (muscle
twitch, a small, local, involuntary
muscle contraction and relaxation
 MG– MEDICAL MANAGEME
------------------------
• Immunosuppressive therapy
(Corticosteroids)
• Plasmapheresis
• Intravenous Immune Globulin
• Thymectomy – removal of the
thymus gland, can produce antigen
specific immunosuppression and
MG – NURSING DIAGNOSES
------------------------
1. Impaired physical
mobility
2. Ineffective breathing
pattern
3. Risk for aspiration
 MG – NURSING
INTERVENTIONS
------------------------
• Promote oxygenation
• Have emergency intubation
equipment ready
• Monitor for possible
myasthenic and cholinergic
MYASTHENIC CRISIS VS CHOLINOSTERASE C
MYASTHEN CHOLINOSTE
IC CRISIS RASE CRISIS
a worsening of caused by an
the disease that overdose of
necessitates
anticholinestera
therapy with
anticholinestera se drugs
se drugs
Both conditions are marked by severe muscle
weakness and dyspnea
 MG – NURSING
INTERVENTIONS
------------------------
• Assess neurologic status
• Assess client’s gag reflex
• Plan activities early in the day or
during energy peaks that follow
administration of medications.
• Encourage the clients to eat
 MG – NURSING
INTERVENTIONS
------------------------
• Allow verbalization of feelings
• Emphasize importance of drug
compliance
• Clients may tape the eyes for
short intervals when eyelids do
not close completely
 •PLEASE
INSERT HERE
THE VIDEO
ON MG!!!!!!!
OPEN FORUM
GAMES
 DIFFERENCES AND
SIMILARITIES
GBS MS MG

DOM
Is the color of Is the colour of Is the color of
gold, butter and the clear sky blood, and
ripe lemons. In and the deep because of this
the spectrum of sea. It is located it has
visible light, between violet historically been
yellow is found and green on associated with
between green the optical sacrifice, danger
and orange. spectrum. and courage.

123
SYNTHESIS
 WORKING COMMITTEES:
Gilliand I. De Castro
Team Leader,Speaker, Theme & Title, Teaching Plan, General & Specific Objectives, Seminar Content,
Powerpoint Presentation

Karl Gabriel S. Abdon

Speaker, Cranial Nerve Assessment Video, Food & Budget Plan, Handouts

Joseph Dominique B. Abel

Speaker, Registration, Evaluation Form

Angelica Monique S. Agbay

Evaluation Form, Registration, Post Test, Seminar Content, Decoration

Bhea Marie P. Añoso

Speaker, Invitation, Certificates, Checklist, House rules, Tarpaulin, Pre Test, Seminar Content, Hand outs

Mariwill J. De Castro
Cranial Nerve Song, Seminar Content, Decoration

Leanza Mildred Z. Etorma

Seminar Kit, Name Tags, Food & Budget Proposal, Tarpaulin, Decoration

Lorenz Aubrey R. Valenzuela

Seminar Content, Registration, Decoration

Filipinas G. Abundabar, MSN

Clinical Instructor
 REFERENCES

• Smeltze et al. 2010, Brunner

and Suddarth’s Textbook of
Medical- Surgical Nursing
Twelfth Edition p.1956-1971
• One Quest Academic Services
Booklet
THANK